Xanthogranulomatous cholecystitis managed by laparotomy may go through troublesome clinical course: Reflection of severe inflammation

Xanthogranulomatous cholecystitis (XGC) is an uncommon inflammatory disease of the gallbladder, and its incidence is reported to be 1.3%-5.2% [1] . XGC is diagnosed by histopathological examination, characterized by severe inflammatory destruction followed by a granulomatous reaction, marked proliferative fibrosis, and infiltration of inflammatory cells [2]. Despite being a benign disease, XGC can exhibit aggressive behavior by extending the range of inflammation to neighboring organs, resulting in adhesions, perforation, abscess formation, and fistulous communication with the bowel [3]. Therefore, it is very difficult to distinguish XGC from gallbladder cancer based on preoperative images and clinical representation. It is usually not possible to diagnose XGC before surgery. The ambiguity of the diagnosis and its inherent invasive nature make it difficult to determine the method of operation. If the diagnosis of XGC is clear, the definite treatment is simple cholecystectomy with or without combined resection of the involved organ [4,5]. However, the involvement of multiple organs makes the surgery difficult and requires a radial operation. Several reports do not recommend the laparoscopic approach because of the high conversion rate of up to 80%, prolonged operative time, and high complication rate. Whereas, there are a few studies on the clinical outcomes of the open radical approach [2,4,6]. This study focused on different surgical types for XGC under different clinical outcomes according to different surgical types, which may reflect the invasiveness of XGC.